Drug eluting insert for implantable body

ABSTRACT

The present application discloses embodiments related to an implant and a method of forming an implant configured to treat a fractured bone. The implant can include a body having a proximal end, a distal end, and an outer surface extending from the proximal end to the distal end, wherein the body defines a central axis extending from the proximal end to the distal end; and a high tensile strand positioned adjacent the body such that at least a portion of the strand extends at least partially along the outer surface of the body in a direction substantially parallel with the central axis, and wherein the strand is loaded with an active agent.

CROSS REFERENCE TO RELATED APPLICATIONS

This is a continuation application of U.S. patent application Ser. No.13/767,061 filed Feb. 14, 2013, which in turn claims benefit to U.S.Provisional Application No. 61/599,568 filed Feb. 16, 2012, hereinincorporated by reference in its entirety.

TECHNICAL FIELD

The present disclosure relates generally to orthopedics. Morespecifically, the present disclosure relates to a system and method fortreatment of fractured bone.

BACKGROUND

Orthopedic implant related infection is a potentially catastrophiccomplication of orthopedic trauma surgery, often requiring extendedsystemic antibiotic therapy, reoperation, and hardware removal. There isalways a risk of infection following any surgical procedure where theprotective barrier of the skin is damaged, however when a permanentsurgical implant such as an intramedullary nail or osteosynthesis plateremains in the body, the quantity of contaminating bacteria required tocause an infection is significantly reduced. The development of a systemand method for local delivery of antibiotics in conjunction with animplant, such as an intramedullary nail, in which the drug deliverymechanism is not permanently attached to the implant, and which can beapplied to a variety of different implants of different sizes and indifferent anatomical locations at the time of surgery could greatlyimprove the effectiveness of treatment involving orthopedic traumasurgery.

SUMMARY

Various embodiments of an implant configured to treat a fractured boneare disclosed. In one embodiment the implant includes a body having aproximal end, a distal end, and an outer surface extending from theproximal end to the distal end, wherein the body defines a central axisextending from the proximal end to the distal end; and a high tensilestrand positioned adjacent the body such that at least a portion of thestrand extends at least partially along the outer surface of the body ina direction substantially parallel with the central axis, and whereinthe strand is loaded with an active agent.

In another embodiment the implant includes a body having a proximal endand a distal end, wherein the body defines a central axis extending fromthe proximal end to the distal end; a cap that is affixed to the distalend of the body when the body is implanted; and a high tensile strandreceived by the cap, wherein the strand is loaded with an active agent.

In another embodiment the implant includes an intramedullary nail havinga proximal end, a distal end, an outer surface extending from theproximal end to the distal end, and an inner surface that defines acannula, the cannula extends in a direction coaxial with the centralaxis along at least a portion of the implant, and a high tensile strandpositioned adjacent the nail such that the strand is at least partiallydisposed within the cannula and at least partially extends along theouter surface of the nail, and wherein the strand is loaded with anactive agent.

In another embodiment the implant includes a bone plate and a hightensile strand. The bone plate includes an outer surface, including, forexample, a bottom surface and an opposed top surface; a distal end, anopposed proximal end and a central axis extending from the distal end tothe proximal end; and a body that extends from the distal end to theproximal end along a direction parallel to a central axis, the bodyfurther extends from the bottom surface to the top surface along adirection perpendicular to the central axis. The high tensile strand isloaded with an active agent and positioned adjacent the bone plate suchthat the strand is at least partially disposed adjacent the outersurface such that the strand extends along the outer surface in adirection substantially parallel to the central axis.

Methods of forming an implant having an active agent are also disclosed.For example, in one embodiment the method includes the step of affixinga high tensile strand containing an active agent to an implantable body,wherein the implantable body has a proximal end and a distal end, anouter surface extending from the proximal end to the distal end, andwherein the body defines a central axis extending from the proximal endto the distal end, and wherein at least a portion of the affixed strandextends along a portion of the outer surface of the body in a directionsubstantially parallel with the central axis.

In another embodiment, the method for forming an implant having anactive agent includes the steps of affixing a high tensile strand to animplantable body, the high tensile strand containing an active agent,the implantable body has a proximal end, a distal end, and a centralaxis extending from the proximal end to the distal end, wherein the bodyincludes a cap that is affixed to the distal end of the body when thebody is implanted, and wherein the strand is affixed to the cap.

A system configured to form an implant having an active agent is alsodisclosed. In one embodiment the system includes an implantable bodyhaving a proximal end, a distal end, and an outer surface extending fromthe proximal end to the distal end, wherein the body defines a centralaxis extending from the proximal end to the distal end, a strandretention mechanism including a cap and a ring, wherein the cap isaffixed to the distal end of the body when the strand retentionmechanism is implanted and the ring is removably securable to the outersurface of the body, and wherein the ring is slidable along the outersurface of the body from the distal end to the proximal end, and aplurality of high tensile strands configured to be affixed to the capand removably securable to the ring, wherein at least a portion of eachof the plurality of strands extends along a portion of the outer surfaceof the body in a direction from the cap to the ring, and wherein thestrand is loaded with an active agent.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing summary, as well as the following detailed description ofthe preferred embodiments of the application, will be better understoodwhen read in conjunction with the appended drawings. For the purposes ofillustrating the surgical instruments and methods of the presentapplication, there is shown in the drawings preferred embodiments. Itshould be understood, however, that the application is not limited tothe specific embodiments and methods disclosed, and reference is made tothe claims for that purpose. In the drawings:

FIG. 1A is a side view of a fractured bone;

FIG. 1B is a side view of an implant being inserted into the fracturedbone illustrated in FIG. 1A, the implant including a body, a strand, anda strand retention mechanism;

FIG. 2A is a side elevation view of the body of the implant illustratedin FIG. 1B;

FIG. 2B is a front view of the body of the implant illustrated in FIG.1B;

FIG. 3A is a perspective view of the strand and the strand retentionmechanism illustrated in FIG. 1B, the strand retention mechanismincluding a cap and a ring member;

FIG. 3B is a side elevation view of the cap according to anotherembodiment;

FIG. 3C is a side elevation view of the cap illustrated in FIG. 3A;

FIG. 3D is a front view of the ring member illustrated in FIG. 3Aaccording to one embodiment;

FIG. 3E is a front view of the ring member illustrated in FIG. 3Aaccording to another embodiment;

FIG. 3F is a front view of the ring member illustrated in FIG. 3Aaccording to another embodiment;

FIG. 4A is a cross-section view of the body and the strand illustratedin FIG. 1B;

FIG. 4B is a cross-section view of the body and the strand illustratedin FIG. 1B according to another embodiment;

FIG. 4C is a cross-section view of the body and the strand illustratedin FIG. 1B and an insertion tool according to one embodiment;

FIG. 4D is a cross-section view of the body and the strand illustratedin FIG. 1B and an insertion tool according to another embodiment;

FIG. 4E is a cross-section view of the body and the strand illustratedin FIG. 1B and an insertion tool according to another embodiment;

FIG. 4F is a cross-section view of the body, the strand, and the strandretention mechanism illustrated in FIG. 1B, according to one embodiment;

FIG. 4G is a cross-section view of the body, the strand, and the strandretention mechanism illustrated in FIG. 1B, according to anotherembodiment;

FIG. 4H is a cross-section view of the body, the strand, and the strandretention mechanism illustrated in FIG. 1B, according to anotherembodiment;

FIG. 4I is a cross-section view of the body, the strand, and the strandretention mechanism illustrated in FIG. 1B, according to anotherembodiment;

FIG. 4J is a cross-section view of the body, strand, and the strandretention mechanism illustrated in FIG. 1B according to anotherembodiment;

FIG. 4K is a cross-section view of the body, strand, and the strandretention mechanism illustrated in FIG. 1B according to anotherembodiment;

FIG. 4L is a cross-section view of the body, strand, and the strandretention mechanism illustrated in FIG. 1B according to anotherembodiment;

FIG. 4M is a cross-section view of the body, strand, and the strandretention mechanism illustrated in FIG. 1B according to anotherembodiment;

FIG. 5A is a side elevation view of the implant illustrated in FIG. 1Bin an unassembled configuration;

FIG. 5B is a side elevation view of the implant illustrated in FIG. 1Bin an assembled configuration;

FIG. 6A is a side elevation view of one step of the insertion of theimplant illustrated in FIG. 1B into a bone;

FIG. 6B is a side elevation view of another step of the insertion of theimplant illustrated in FIG. 1B into the bone;

FIG. 6C is a side elevation view of another step of the insertion of theimplant illustrated in FIG. 1B into the bone;

FIG. 6D is a side elevation view of another step of the insertion of theimplant illustrated in FIG. 1B into a bone;

FIG. 7A is a front cross-section view of the strand illustrated in FIG.1B according to one embodiment;

FIG. 7B is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7C is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7D is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7E is a side cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7F is a side cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7G is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7H is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7I is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7J is a side cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7K is a side cross-section view of the strand illustrated in FIG.1B according to another embodiment;

FIG. 7L is a front cross-section view of the strand illustrated in FIG.1B according to another embodiment

FIG. 8A is a bottom plan view of a strand secured to a bone plateaccording to one embodiment;

FIG. 8B is a bottom plan view of the strand secured to the bone plateillustrated in FIG. 8A, according to another embodiment;

FIG. 8C is a cross section view of the strand secured to the bone plateillustrated in FIG. 8B;

FIG. 8D is a bottom plan view of the strand secured to the bone plateillustrated in FIG. 8A, according to another embodiment.

DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS

Certain terminology is used in the following description for convenienceonly and is not limiting. The words “distal” and “proximal” refer todirections toward and away from, respectively, the patient's body. Thewords “front”, “rear”, “right”, “left”, “lower” and “upper” designatedirections in the drawings to which reference is made. The words,“anterior”, “posterior”, “superior”, “inferior” and related words and/orphrases designate illustrative positions and orientations in the humanbody to which reference is made and are not meant to be limiting. Theterminology includes the above-listed words, derivatives thereof andwords of similar import. Additionally, a three dimensional coordinatesystem is used to describe the positions and orientations of the partsof the implant. The coordinate system includes a longitudinal directionL, a lateral direction A, and a transverse direction T, wherein each ofthe directions is perpendicular to both of the other two directions.

The term “plurality”, as used herein, means more than one. When a rangeof values is expressed, another embodiment includes from the oneparticular value and/or to the other particular value. Similarly, whenvalues are expressed as approximations, by use of the antecedent“about,” it will be understood that the particular value forms anotherembodiment. Further, reference to values stated in ranges include eachand every value within that range. All ranges are inclusive andcombinable. Certain features of the invention which are described hereinin the context of separate embodiments, may also be provided incombination in a single embodiment. Conversely, various features of theinvention that are described in the context of a single embodiment, mayalso be provided separately or in any subcombination.

Referring to FIGS. 1A and 1B, a fractured bone 1 includes a medullarycavity 2, located within the main shaft of the bone 1, and a fracture 3.The fractured bone 1 can be treated by inserting an implant 10 into thebone 1. The implant 10 can be constructed so as be inserted andpositioned within the medullary cavity 2 of the bone 1. The implant 10can include a body 20, a strand 60, and a strand retention mechanism 70that secures the strand 60 relative to the body 20. The body 20 can beelongate in the longitudinal direction L, the body extending from adistal end 22 to a proximal end 24 along a central axis 26.

The strand 60 is configured to be secured relative to the body 20 andthe strand 60 can be loaded with an active agent. In one embodiment thestrand 60 can be a suture, a wire, or any other appropriate thread-likematerial. In another embodiment the strand 60 can be a thin ribbon ofmaterial, such as a strip cut from an extruded film, or a woven orbraided textile with a flat geometry. In one embodiment, the activeagent can be an antibiotic (such as, for example, gentamicin), theactive agent being selected as appropriate to reduce or prevent thechance of infection at the implantation site of the implant 20. Thestrand retention mechanism 70 is attachable to the body 20 andconfigured to secure the strand 60 relative to the body 20 such that theactive agent is distributed about the implant 10 as desired.

In use, the distal end 22 of the body 20 can be inserted into themedullary cavity 2 of the fractured bone 1 and the body 20 can then beadvanced within the medullary cavity 2 until the distal end 22 ispositioned on one side of the fracture 3 and the proximal end 24 ispositioned on another side of the fracture 3, thus providing fixationfor the fractured bone 1 while the fractured bone 1 heals. The use ofthe implant 10 in the treatment of fractured bone 1 will be described ingreater detail below.

Referring to FIGS. 2A and 2B the body 20 has a length that is measuredfrom the distal end 22 to the proximal end 24 along the central axis 26.The body can further include an outer surface 28 that extends from thedistal end 22 to the proximal end 24. The outer surface 28 can define anouter diameter D1 of the body 20. The outer diameter D1 of the body 20can vary such that an implant 10 can be chosen with an appropriate sizedouter diameter D1 of the body 20 to treat a particular fractured bone.For example, the outer diameter D1 of a body 20 used to treat afractured femur may be larger than the outer diameter D1 of a body 20used to treat a fractured rib. In one embodiment the outer surface 28 ofthe body 20 can be round, as shown. Alternatively, the outer surface 28can be tubular or any other shape that is configured to be slidablyinserted into the medullary cavity of a bone.

The body 20 can also include an inner surface 30 that defines a cannula(or recess) 32 that extends through at least a portion of the length ofthe body 20, such that, for example, a passageway is open through theinterior of the body 20 from the distal end 22 to the proximal end 24.The inner surface 30 can also define an inner diameter D2. In oneembodiment the inner surface 30 can be round, as shown, such that across-section of the cannula is a circle. Alternatively, the innersurface 28 can be any other shape as long as an open passageway isprovided through the interior of the body 20.

In one embodiment the body 20 can further include a first portion 34 anda second portion 36 directly connected to the first portion 34. Thefirst portion 34 includes the distal end 22 and the second portion 36includes the proximal end 24. As shown, the first portion 34 can bealigned parallel to the longitudinal direction L and the second portion36 can be angularly offset (by an angle α) from the first portion 34with respect to the longitudinal direction L such that the body 20 isbent. The angle α can vary from about 0° (such that the body 20 is notbent) to about 45°. Specifically, the angle α can be about 10° in oneembodiment. The body 20 can include a radius at the bend such that body20 is smooth through the bend. The body 20 can be selected with theappropriate angle α to aid in insertion of the body 20 and also to aidin alignment of the fractured bone when the body 20 has been placed inthe medullary cavity 2 of the fractured bone 1. Entry sites for someintramedullary nails are drilled at an angle to avoid joint surfaces orligaments, the angle α can be selected to correspond to the angle of theentry site.

The body 20 can also define one or more apertures, such as for examplelocking apertures 38. Each of the one or more locking apertures 38extends through the body 20 in a direction substantially perpendicularto the central axis 26. The locking apertures 38 can be of variousshapes and sizes such that the locking apertures 38 are configured toreceive a locking member or a fastener (such as, for example, a nail ora screw). Once the body 20 has been positioned within the fractured bone1, the locking apertures 38 can each receive a locking member to securethe position of the body 20 relative to the fractured bone. As shown,the locking apertures 38 can be disposed at various locations along thelength of the body 20. One or more locking apertures 38 can be locatedin the distal end 22 and one or more locking apertures 38 can be locatedin the proximal end 24.

Referring to FIGS. 3A-3D, the strand retention mechanism 70 isconfigured to secure the strand 60 relative to the body 20 duringinsertion of the implant 10 into the fractured bone 1. The strandretention mechanism 70 can include a cap or insert 72 (hereinafterreferred to as cap) configured to be affixed to the distal end 22 of thebody 20 and a ring member 82 that is configured to be received by theouter surface 28 of the body 20. In one embodiment the ring member 82can be a completed ring, or alternatively the ring member 82 can be apartial ring (for example C-shaped or U-shaped). The cap 72 can beaffixed to the distal end 22 of the body 20 in various ways based on thestructure of the cap 72. For example, in one embodiment the cap 72 canbe disposed at least partially within the cannula 32 of the body 20. Inanother embodiment the cap 72 can fit over the outer surface 28 of thedistal end 22 of the body 20, for instance like a sleeve. In stillanother embodiment the cap 72 can be affixed to the distal end 22 of thebody 20 by using an adhesive. The reference number 72 as used throughoutthis disclosure refers to the cap or insert in general. Specificembodiments of the cap 72 are described below and each embodiment isidentified by an increasing increment of 100 (172, 272, 372, etc.). Anydescription of the general cap 72 can be combined with any of thespecific embodiments of the cap 172, 272, 372, etc.

Referring to FIG. 3B, the cap 172 as shown includes a shaft 174 and atip 176 that is directly coupled to the shaft 174. The shaft 174 definesan outer diameter D3, the outer diameter D3 being configured such thatthe shaft 174 can be received within the cannula 32 of the body 20. Whenthe cap 172 has been received within the body 20 as described above, thetip 176 can be the leading edge of the implant 10 as the implant 10 isinserted into the medullary cavity 2 of a fractured bone 1. Therefore,in one embodiment the tip 176 can be dome shaped to facilitate insertionof the implant 10 into the bone 1. In one embodiment the tip 176 definesan outer diameter D4 that is greater than the inner diameter D2 of thecannula 32 such that the tip 176 of the cap will not fit entirely withinthe cannula 32. Additionally, it is preferable that the tip 176 hassufficient mechanical strength to withstand the forces experienced bythe implant 10 during insertion into the fractured bone 1, which canoften require repeated blows with a hammer. Although the cap 172 hasbeen described above as including a shaft 174 and tip 176, in anotherembodiment the cap 172 can include any shape such that the cap 172 isconfigured to be partially received within the cannula 32 of the body 20and secured relative to the body 20. For example, the cap 172 can becylindrical, wedge shaped, cork shaped, or plug shaped.

The cap 172 can further include at least one strand securing element 178that is configured to secure the strand 60 relative to the cap 172 suchthat as the distal end 22 and the attached cap 172 are advanced into themedullary cavity 2 of the fractured bone 1, the strands 60 are alsoadvanced into the bone 1. In one embodiment the strand securing element178 can be a bore that the strand 60 is passed through. In anotherembodiment the strand securing element 178 can include a recess that iscrimped closed once the strand has been positioned within the recess. Inyet another embodiment the strand securing element 178 can be a notch orhook that receives and secures the strand 60. The strand securingelements 178 can be positioned within the shaft 174 (for strands 60 thatare to be disposed within the cannula 32 of the body 20), positionedwithin the tip 176 (for strands 60 that are to be disposed outside thebody 20 and adjacent to the outer surface 28 of the body), or both. Inyet another embodiment, the strands 60 are insert molded into aninjection molded cap 172 or attached using an adhesive.

Referring to FIG. 3C, in another embodiment the strand retentionmechanism 70 can include a cap 272. Cap 272 defines a leading surface274, a trailing surface 276 and a body 278 that extends from the leadingsurface 274 to the trailing surface 276. As shown in the illustratedembodiment, the body 278 can have a plug-like or cork-like shape. Thecap 272 further defines an outer diameter D3 located near the trailingsurface 276, the outer diameter D3 being smaller than the inner diameterD2 of the cannula 32 such that the cap 272 can be at least partiallyreceived within the cannula 32 of the body 20. In one embodiment the cap272 also defines an outer diameter D4 located near the leading surface274, the outer diameter D4 being greater than the inner diameter D2 ofthe cannula 32 such that the cap 272 does not fit entirely within thecannula 32. The leading surface 274 can include one or more strandsecuring elements 78 (see, for example, FIG. 3B) that are configured tosecure the one more strands 60 relative to the cap 272. In anotherembodiment, the strands 60 can be secured to the leading surface 274 insuch way, for instance by an adhesive, that a strand securing element isnot needed on the cap 272.

The caps 172 and 272 as illustrated in FIGS. 3B and 3C are eachconfigured to be disposed at least partially within the cannula 32 ofthe body 20. However, other embodiments of the cap 72 are contemplated.In another embodiment the cap 72 can be configured such that the entirecap 72 fits within the cannula 32 of the body 20. This positioning ofthe cap 72 can decrease the chance of damage to the cap 72 duringinsertion of the implant 10. In yet another embodiment the cap 72 can beconfigured such that the entire cap 72 is disposed outside of thecannula 32 of the body 20. As will be described in greater detail belowin reference to FIG. 4C, the cap 372 can be a sleeve-like shape that isconfigured to fit over the outer surface 28 of the distal end 22 of thebody 20. The various embodiments of the cap 72 can be constructed froman appropriate material that is selected based on the intended use ofthe cap 72. For example, the cap 72 can be made from a biodegradable orbioresorbable material, for instance polylactic acid (PLA), polyglycolicacid (PGA), polycaprolactone (PCL), polymethylene carbonate (PMC),polyethylene glycol (PEG) or copolymers of these. A biodegradable orbioresorbable material can be beneficial if it is desired that the cap72 not be removed after insertion. In another embodiment the cap 72 canbe made of a non-biodegradable or non-bioresorbable material, forinstance polyethylene, high-density polyethylene (HDPE), ultra-highmolecular weight polyethylene (UHMWPE), polypropylene, polyether etherketone (PEEK), nylon, acrylic, or polyurethane. The cap 72 can also beloaded with active agent by any of the methods described throughout thepresent disclosure.

Referring to FIGS. 3A and 3D-3F, the ring member 82 can include a frontsurface 83, an opposed rear surface 84 and a length defined as thedistance from the front surface 83 to the rear surface 84. The ringmember can also have an inner surface 85 that defines a bore 86extending through the ring member 82, as shown the bore can be centeredon a central axis 87. The bore 86 has a complementary size and shape tothe outer surface 28 of the body 20 such that when the central axis 87of the bore is aligned with the central axis 26 of the body 20, the ringmember 82 is slidable along the outer surface 28 of the body 20. In oneembodiment, the bore 86 can be a circle with an inner diameter D5, asshown. The inner diameter D5 is slightly larger than the outer diameterD1 of the body 20. The ring member 82 can further include an outersurface 88 that defines an outer diameter D6 of the ring member 82. Theouter diameter D6 is greater than the inner diameter D5, such that athickness is defined between the inner surface 85 and the outer surface88 measured along a direction from the inner surface 85 to the outersurface 88 and perpendicular to the central axis 87.

The ring member 82 can additionally include one or more strand securingelements 90 that are configured to secure the one more strands 60relative to the outer surface 28 of the body 20 in a desired orientationduring insertion of the implant 10 into the medullary cavity 2. As shownin FIG. 3D, the strand securing elements 90 include recesses or notches92 that extend from the outer surface 88 toward the inner surface 85.The recesses 92 can run the length of the ring member 82 creating apassageway through a portion of the ring member 82, the passageway beingconfigured to slidably receive the strand 60.

In another embodiment as shown in FIG. 3E, the strand securing elements90 can include through bores 93 that extend from the front surface 83toward the opposed rear surface 84. The bores 93 can run the length ofthe ring member 82 creating a passageway through a portion of the ringmember 82, the passageway being configured to slidably receive thestrand 60. The number and positioning of the through bores 93 can varyas desired to accommodate a specific number of strands 60 and retain thestrands 60 in desired relative positions to one another. For example,the ring member 82 includes one or more, for instance four, throughbores 93 evenly spaced through bores about the circumference of the ringmember 82. In another embodiment the through bores 93 can be positionedwithin the ring member 82 such that the through bores 93 are not evenlyspaced from one another.

As shown in FIG. 3F, in another embodiment the strand securing elements90 include a flange 94 with a hole 96. The hole 96 is configured toslidably receive the strand 60 such that the strand 60 can translatethrough the hole 96. In yet another embodiment the strand securingelement 90 can include any structure that is configured to slidablyreceive the strand 60 and secure the strand 60 relative to the body 20during insertion of the implant 10 into the bone 1.

Referring to FIG. 4A, in one embodiment the implant 10 includes the body20 and the strand 60. The implant 10 as shown is in an assembledconfiguration ready for implantation. The strand 60 has been positionedrelative to the body 20 such that the strand 60 is partially disposedwithin the cannula 32 of the body 20 and partially disposed outside ofthe body 20, adjacent to (for example abutting) the outer surface 28. Asshown, the strand 60 passes through the cannula 32 at the distal end 22(the distal end 22 shown including a locking aperture 38) such that thestrand 60 is partially disposed within the cannula 32 and partiallydisposed outside the body 20 adjacent the outer surface 28. In thisembodiment the implant 10 does not include a strand retention mechanism70. Although the strand 60 is shown passing through the cannula 32 ofthe body 20 once, in another embodiment the strand 60 can be loopedthrough the cannula 32 around the outer surface 28 of the body 20 andback through the cannula 32 more than once, increasing the area of theimplant 10 that has active agent on it.

Referring to FIG. 4B, the strand 60 is partially disposed within thecannula 32 of the body 20 and partially disposed outside of the body 20,adjacent to the outer surface 28, similarly to FIG. 4A as describedabove. However, as shown in the illustrated embodiment, the strand 60passes through the locking aperture 38 to transition from inside thecannula 32 to outside the body 20. In another embodiment the strand 60can be passed through any apertures or holes in the body 20 to positionthe strand 60 as desired relative to the body 20. Typically, the strandextends along the outer surface of the body in a direction substantiallyparallel with the central axis, but the strand may also extend along theouter surface of the body in other directions.

Referring to FIGS. 4C-4E, an insertion tool 196 can be used to threadthe strand 60 through the cannula 32 of the body 20. As shown in FIG. 4Cthe insertion tool 196 includes a needle-like body 197. The needle-likebody 197 can include a lead end 198 and an eyelet 199, the eyelet 199being disposed near the lead end 198 and configured to receive andretain the strand 60 during insertion of the strand 60 into the cannula32 of the body 20. In use, the strand 60 is secured within the eyelet199 of the needle-like body 197. The needle-like body 197 is then passedinto and through the cannula 32 in a direction from the proximal end 24toward the distal end 22. Once the strand 60 has passed through thedistal end 22 the strand 60 can be removed from the eyelet 199 and theneedle-like body 197 can then be withdrawn back through the cannula 32in a direction from the distal end 22 toward the proximal end 24.

As shown in FIG. 4D, the insertion tool 196 can include a rod-like body297. The rod-like body 297 defines a lead end 298 and inner bore 299.The strand 60 is secured to the lead end 298 of the insertion tool 297and the inner bore 299 encloses at least a portion of the strand 60during insertion through the cannula 32. The rod-like body 297 is passedinto and through the cannula 32 in a direction from the proximal end 24toward the distal end 22. Once the strand 60 has passed through thedistal end 22 the strand 60 can be detached from the lead end 298 andthe rod-like body 297 can then be withdrawn back through the cannula 32in a direction from the distal end 22 toward the proximal end 24 leavingthe strand 60 threaded through the length of the cannula 32.

As shown in FIG. 4E, the insertion tool 196 can include a weight 297attached to the strand 60. The weight 297 can be any shape that fitswithin the cannula 32. In use the strand 60 can be attached to theweight 297, for instance by knotting the strand 60 to the weight 297.The body 20 can be oriented vertically such that the proximal end 24faces up and away from the ground and the distal end 22 faces down andtoward the ground. The weight is then passed into the cannula 32 at theproximal end 24 and gravity fed toward the distal end 22. Once theweight 297 and the strand 60 have passed through the distal end 22 ofthe body 20 the weight 297 can be removed from the strand 60. In anotherembodiment the body 20 can be oriented vertically such that the distalend 22 faces up and away from the ground and the proximal end 24 facesdown and toward the ground. The weight is passed into the cannula 32 atthe distal end 24 and gravity fed toward the proximal end 22.

Referring to FIGS. 4F and 4G, in another embodiment the implant 10includes the body 20, the strand 60, and the strand retention mechanism70 (including the cap 172). The implant 10 is shown in an assembledconfiguration ready for implantation. The shaft 174 of the cap 172 hasbeen positioned within the cannula 32 at the distal end 22 of the body20, such that the cap 172 and the body 20 are secured relative to oneanother. In one embodiment the strand 60 can be secured to the shaft 174of the cap 172 such that the strand 60 is positioned entirely within thecannula 32 of the body 20. In another embodiment the strand 60 can besecured to the tip 176 of the cap 172 such that the entire strand 60 ispositioned outside the cannula 20 and adjacent to the outer surface 28of the body 20 (not shown). In another embodiment the implant 10 caninclude multiple strands 60 (referred to herein as first strand 60′ andsecond strand 60″). One or more first strands 60′ can be secured to theshaft 174 of the cap 172 such that the first strands 60′ are positionedentirely within the cannula 32 of the body 20. Additionally, one or moresecond strands 60″ can be secured to the tip 176 of the cap 172 suchthat the second strands 60″ are positioned entirely outside the cannula20 and adjacent to the outer surface 28 of the body 20. In thisembodiment the strand retention mechanism 70 is not shown as including aring member 82, but a ring member 82 could be included.

Referring to FIG. 4H, the implant as shown includes the body 20, thestrand 60, and the strand retention mechanism 70 (including the cap372). The implant 10 is shown in an assembled configuration ready forimplantation. The cap 372 is configured to fit over the outer surface 28at the distal end 22 of the body 20. The cap 372 fits over the outersurface 28 at the distal end 22 of the body 20 like a sleeve and ispositioned entirely outside of the body 20. The cap 372 can beconstructed of an elastic or resilient material such that the cap 372stretches as it is fit over the outer surface 28 at the distal end 22 ofthe body 20 and the resilient property of the cap 372 holds the cap 372in place relative to the body 20. As shown, the strand 60 is secured tothe cap 372 such that each of the strands 60 is positioned entirelyoutside of the cannula 20 and adjacent to the outer surface 28 of thebody 20. In this embodiment the strand retention mechanism 70 is notshown as including a ring member 82, but a ring member 82 could beincluded.

Referring to FIG. 4I, in another embodiment the implant 10 includes thebody 20, the strand 60, and the strand retention mechanism 70 (includingthe cap 172 and the ring member 82). The implant 10 is shown in anassembled configuration ready for implantation. The shaft 174 of the cap172 has been positioned within the cannula 32 at the distal end 22 ofthe body 20, such that the cap 172 and the body 20 are secured relativeto one another. The body 20 has been positioned within the ring member82 such that the inner surface 85 of the ring member 82 is in slidablecontact with the outer surface 28 of the body 20. In one embodiment thestrand 60 can be secured to the shaft 174 of the cap 172 such that thestrand 60 is positioned entirely within the cannula 32 of the body 20.In another embodiment the strand 60 can be secured to the tip 176 of thecap 172 such that the entire strand 60 is positioned outside the cannula20 and adjacent to the outer surface 28 of the body 20. In anotherembodiment the implant 10 can include multiple strands 60 (referred toherein as first strand 60′ and second strand 60″). One or more firststrands 60′ can be secured to the shaft 174 of the cap 172 such that thefirst strands 60′ are positioned entirely within the cannula 32 of thebody 20. Additionally, one or more second strands 60″ can be secured tothe tip 176 of the cap 172 such that the second strands 60″ arepositioned entirely outside the cannula 20 and adjacent to the outersurface 28 of the body 20. As shown in the illustrated embodiment, theimplant 10 includes both the first strand 60′ and second strand 60″. Inanother embodiment the implant 10 can include one or more second strands60″ (disposed outside the cannula 32) and none of the first strands 60′(disposed inside the cannula 32). In yet another embodiment the implant10 can include one or more of the first strands 60′ (disposed inside thecannula 32) and none of the second strands 60″ (disposed outside thecannula 32).

The second strands 60″ can be slidably received by the strand securingelement 90 (not shown) of the ring member 82 such that the secondstrands 60″ are held in a desired spaced relationship relative to oneanother. In one embodiment the spaced relationship can include thesecond strands 60″ oriented parallel to each other and being spacedapart radially about the outer surface 28 of the body 20. For example,the implant 10 can include four second strands 60″ each spaced 90° apartabout the outer surface 28. Alternatively, the second strands 60″ canhave non-uniform spacing. In another embodiment the spaced relationshipcan include the second strands 60″ being wound around the outer surface28 of the body 20 such that the second strands 60″ are eithersubstantially parallel to each other or alternatively such that thesecond strands 60″ crisscross with each other.

Referring to FIG. 4J, in another embodiment the implant 10 includes thebody 20, the strand 60, and the strand retention mechanism 70 (includingthe cap 272 and the ring member 82). As shown in the illustratedembodiment, the cap 272 can include a longitudinal bore 273 that extendsthrough the cap 272 such that a passageway is created through the cap272. During implantation of the implant 10, a K-wire 175 or otherguidance mechanism can be passed through the longitudinal bore 273 toaid in implantation of the implant 10. The cap 272 shown in FIGS. 4B-4Dcan also include a longitudinal bore similar to the longitudinal bore273 that is configured to receive a K-wire or other guidance mechanismto aid in the implantation of the implant 10.

Referring to FIGS. 4K-4M, still another embodiment of the implant 10includes the body 20, the strand 60, and the strand retention mechanism70 (including the cap 272 and optionally the ring member 82). As shownin the illustrated embodiment, a connector 180 with an attached strand60 can be inserted through the cannula 32 of the body 20 and secured tothe cap 272. The cap 272, as shown, includes a connector receivingrecess 290. The connector receiving recess 290 is configured to securethe connector 180 relative to the cap 272. The connector 180 defines aleading end 182 with a shape and the connector receiving recess 290defines a shape that corresponds to the shape of the connector 180. Forexample, as shown, the shape of the leading end 182 is rounded orball-shaped and matches the shape of the connector receiving recess 290.In use, the cap 272 is secured to the distal end 22 of the body 20. Thenthe connector 180 attached to an insertion tool 196 is inserted alongthe cannula 32 of the body 20. The insertion tool 196 is advanced towardthe distal end 22 until the leading end 182 of the connector 180 isreceived within the corresponding shape of the connector receivingrecess 290. As shown the leading end 182 and the connector receivingrecess 290 can have corresponding shapes such that the leading end 182snap fits into the connector receiving recess 290. The insertion tool196 can then be withdrawn leaving the connector 180 secured to the cap272 with the strand 60 disposed within the cannula 32 of the body 20.The caps 172 and 372 shown in FIGS. 4F-4I can also include a connectorreceiving recess similar to the connector receiving recess 290 that isconfigured to receive a leading end of a connector as described above.

Referring to FIG. 5A, the implant 10 can include an unassembledconfiguration. The one or more strands 60 include a first end 64 and asecond end 66. The first end 64 of the first strands 60′ attach to theshaft 74 of the cap 72. The second end 66 of the first strands 60′ passthrough the bore 86 of the ring member 82, pass into the cannula 32 ofthe body 20 at the distal end 22, and pass out through the proximal end24. The first end 64 of the second strands 60″ attach to the tip 76 ofthe cap 72. The second end 66 of the second strands 60″ pass through thestrand securing element 90 of the ring member 82 and pass adjacent theouter surface 28 of the body 20.

Referring to FIG. 5B, the implant 10 can include an assembledconfiguration. The distal end 22 of the body 20 receives the cap 72 andthe outer surface 28 receives the ring member 82. Just prior toimplantation the ring member 82 can be positioned adjacent the distalend 22 and the strands 60 are pulled taut and slidably received withinthe strand securing element 90 of the ring member 82.

Referring to FIG. 6A-6D, a method for treating a fractured bone 1includes inserting the implant 10 into the medullary cavity 2 asdescribed in detail below. As shown in FIG. 6A the implant 10 isinserted into the medullary cavity 2 at an insertion site 4 such thatthe cap 72 leads the implant 10 during insertion. The ring member 82,which is positioned about the outer surface 28 of the body 20 at thedistal end 22 contacts the exterior of the bone 1 at the insertion site4. The ring member 82 is configured such that it will abut the exteriorof the bone 1 at the insertion site 4, but not enter the medullarycavity 2. As shown in FIG. 6B the body 20 and the cap 72 of the implant10 have been advanced within the medullary cavity 2 toward the fracture3. The ring member 82 remains in its earlier position abutting theexterior of the bone 1 at the insertion site 4. As the cap 72 and body20 advances within the medullary cavity 2, the strands 60, which aresecured to the cap 72, advance into the medullary cavity 2 as well. Asthe strands 60 advance into the medullary cavity 2 along with the cap72, the strands 60 slide through the strand retention element 90 (notshown) of the ring member 82 while remaining in a desired spacedrelationship throughout the insertion of the implant 10. As shown inFIG. 6C the implant 10 has advanced within the medullary cavity 2 suchthat the body 20 is partially located on both sides of the fracture 3.The strands 60 continue to advance with the cap 72 while the ring member82 maintains the desired spaced relationship of the strands 60 relativeto each other. As shown in FIG. 6D the implant 10 has been fullyinserted such that the entire body 20 is positioned within the medullarycavity 2. The body 20 is partially located on both sides of the fracture3. The ring member 82 has been removed from contact with the outersurface 28 of the body 20. The strands 60 can be tied together orknotted and any excess length can be cut off.

During the insertion process the cap 72 and the strands 60 will besubjected to high shearing forces and thus are preferably configured towithstand those high shearing forces. In one embodiment the body 20 isconfigured such that the strands 60 are in contact with walls 5 thatdefine the medullary cavity 2, and the strands 60 are wedged between thewalls 5 of the medullary cavity 2 and the outer surface 28 of the body20. In other words, the strands 60 may be positioned on the outersurface 28 of the body 20 that, during implantation, typically contactor may contact the walls 5 of medullary cavity 2. The positioning of thestrands 60, in this embodiment, outside of the body 20 subjects thestrands 60 to increased shearing forces during insertion of the implant10 that the strands 60 are typically manufactured and configured towithstand. This method of treatment enables more precise positioning ofstrands 60 and thus more precise delivery of the active agent that thestrands 60 are loaded with.

For example, the strands can be manufactured and configured to move orslide against the walls 5 of the medullary cavity 2 without sustainingdamage or deterioration during implantation. Accordingly, in oneembodiment, a standard intramedullary nail with a cannula can be used asthe body 20 of the implant without the need to alter the surface of theintramedullary nail to incorporate a strand loaded with active agent orotherwise protect the strand from shearing forces. In one embodiment, astrand, such as a bioabsorbable suture, may be axially oriented (drawn)to provide increased tensile strength. The drawn filament may be coatedby a dip-coating process with a bioabsorbable polymer containingparticles of active agent, such as gentamicin sulfate. The particle ofactive agent can be suspended in the polymer or dissolved in the coatingsolution, such that the coating is tenaciously bound to the surface ofthe filament. The filament and/or coating typically has sufficientstrength to be positioned on the outer surface of an intramedullary nailand inserted into the medullary canal of a bone without damaging thesuture or stripping off the coating.

Referring to FIGS. 7A-7L, a variety of strands 60 can be loaded withactive agent 62 in a variety of ways such that the strand 60 retains theactive agent 62 during implantation of the strand 60. For example, thestrand 60 could be spray coated with a solution that includes adrug-polymer-solvent mixture. Additionally, filaments can be extrudedwith the drug so that a secondary coating process is not necessary.Further, the filaments can be electrospun.

The active agent 62 can be used to increase the effectiveness oftreatment of a fractured bone by reducing the risk of or preventinginfection, promoting healing, etc. The active agent can includeparticles 63 (of gentamicin or other antibiotics, in addition to growthfactors, analgesics, and anti-inflammatory compounds, for example) and acoating 65. The strand and/or coating material may include an additiveto make the strand and/or coating material more water permeable orswellable, for the purpose of increasing the drug release rate from thestrand and/or coating.

The coating can include a polymer, such as polyurethanes, that can bebioabsorbable or biostable (non-absorbable). Additional examples ofbioabsorbable polymers can include polylactic acid (PLA), polyglycolicacid (PGA), polycaprolactone (PCL), polymethylene carbonate (PMC),polyethylene glycol (PEG) or copolymers of these. Alternately, thecoating can be made of some material other than a polymer such ascalcium stearate, magnesium stearate, dextran, collagen, gelatin,polypeptides, proteins, or carbohydrates. In one embodiment a layer ofthe active agent 62 can have a thickness of from about 0.01 mm to about0.07 mm.

As shown in FIG. 7A the strand 60 can include a core 68 that is amonofilament. The particles 63 are disposed within the coating 65. Thecoating 65 is layered around the core 68, and the coating 65 is thickerthan the diameter of the particles 63. As shown in FIG. 7B the strand 60can include a core 68 that is a monofilament. The particles 63 aredistributed throughout the core 68. The particles 63 can be distributedevenly or unevenly. In this embodiment the active agent 62 can lack thecoating 65. As shown in FIG. 7C the strand 60 can include a core 68 thatis a monofilament. The particles 63 are disposed within the coating 65.The coating 65 is layered around the core 68, and the coating 65 isthinner than the diameter of the particles 63, such that more of theparticles 63 are exposed.

As shown in FIG. 7D the strand 60 can include a core 68 that ismultifilament. The particles 63 are disposed within the coating 65. Thecoating 65 is layered around the core 68, and the coating 65 is thickerthan the diameter of the particles 63. As shown in FIG. 7E the strand 60can include a core 68 that is a flat strip (or ribbon). In oneembodiment core 68 is made from a polymer material. The particles 63 aredistributed throughout the core 68. The particles 63 can be distributedevenly or unevenly. As shown in FIG. 7F the strand 60 can include a core68 that is a flat strip (or ribbon). In one embodiment the core 68 ismade from a polymer material. The core 68 as shown can be solid polymerwith the coating 65 containing the particles 63 disposed on either sideof the core 68.

As shown in FIG. 7G the strand 60 can include a core 68 that is amonofilament. The coating 65 is layered about the core 68 and thecoating 65 includes dissolved antibiotic. The active agent 62 can lackparticles 63 in this embodiment. As shown in FIG. 7H the strand 60 caninclude a core 68 that is a monofilament. The active agent 62 (notshown) includes dissolved antibiotic distributed through the core 68.The dissolved antibiotic can be distributed evenly or unevenly. Theactive agent 62 can lack the particles 63 and the coating 65 in thisembodiment. As shown in FIG. 7I the strand 60 can include a core 68 thatis multifilament. The coating 65 is layered about the core 68 and thecoating 65 includes dissolved antibiotic. The active agent 62 can lackparticles 63 in this embodiment.

As shown in FIG. 7J the strand 60 can include a core 68 that is a flatstrip (or ribbon). In one embodiment the core 68 is made from a polymermaterial. The active agent 62 (not shown) includes dissolved antibioticdistributed through the core 68. The dissolved antibiotic can bedistributed evenly or unevenly. The active agent 62 can lack theparticles 63 and the coating 65 in this embodiment. As shown in FIG. 7Kthe strand 60 can include a core 68 that is a flat strip (or ribbon). Inone embodiment the core 68 is made from a polymer material. The core 68as shown can be solid polymer with the coating 65 containing dissolvedantibiotic disposed on either side of the core 68. The active agent 62can lack particles 63 in this embodiment. As shown in FIG. 7L the strand60 can include a core 68 that is a monofilament. The particles 63 aredisposed within the coating 65. The coating 65 is layered around thecore 68, and the coating 65 is thinner than the diameter of theparticles 63. As shown the active agent can include a barrier coating67, for example formed by a second layer of polymer, such that a barrierprotects the particles 63 from exposure.

Referring to FIGS. 8A-8D, an implantable body can also include a strand60 secured to other types of implants, such as a bone plate 500. Thebone plate 500 includes an outer surface, that can include a bottombone-contacting surface 501, an opposed top surface 503, and an outerperiphery 513. The bone plate 500 also includes opposed ends, forinstance a distal end 505 and a proximal end 507. The bone plate 500further includes a body 509 that extends from the distal end 505 to theproximal end 507 along a direction parallel to a central axis 511, suchthat the body 509 defines a length. The body 509 also extends from thebottom surface 501 to the top surface 503 along a directionperpendicular to the central axis 211, such that the body 509 defines athickness. The body 509 further defines at least one aperture, forexample at least one fastener hole 502, 504, 506, 508, 510 that extendsfrom the bottom surface 501 to the top surface 503. Each of the fastenerholes 502 is typically configured to receive a bone fastener, forinstance a non-locking bone screw that secures the bone plate 500 to anunderlying bone. The bone plate 500 can include one or more of a singlenon-locking screw hole 502, a multi locking and non-locking screw hole504, a multi locking screw hole 506, a multi non-locking screw hole 508,a single locking screw hole 510 or any combination thereof. In general,any of the fastener holes 502, 504, 506, 508, 510 may be used whether ornot the fastener holes 502, 504, 506, 508, 510 ultimately receive ascrew or fastener during application. In another embodiment the strandcan be attached to the bone plate without the use of any fastener holes502, 504, 506, 508, 510, for instance by using an adhesive to secure thestrand 60 to either the bottom surface 501 or the top surface 503. Inother embodiments (not shown), an insert or cap similar to thosedescribed herein may be used as the strand retention mechanism andconfigured to fit within or over one or more of the fastener holes toanchor the strand to the bone plate.

As shown in FIG. 8A, the strand 60 can be secured to the bone plate 500as shown by passing the strand 60 through one of the fastener holes 502,504, 506, 508, 510 and tying a knot in the strand 60. Once the strand 60has been looped through one of the fastener holes 502, 504, 506, 508,510 the remainder of the strand 60 can be positioned along the bottomsurface 501 of the bone plate 500. Upon insertion the strand 60 will bepositioned between the bone plate 500 and the underlying bone to deliverthe active agent loaded on the strand 60 and prevent medicalcomplications. In another embodiment, once the strand 60 has been loopedthrough one of the fastener holes 502, 504, 506, 508, 510 the remainderof the strand 60 can be positioned along the top surface 503 of the boneplate 500. Upon insertion the strand 60 will be positioned between thebone plate 500 and a soft tissue layer to deliver the active agentloaded on the strand 60 and prevent medical complications. In stillanother embodiment, one or more strands 60 can be positioned on both thebottom surface 501 and the top surface 503. Typically, the strandextends along the outer surface in a direction substantially parallel tothe central axis, but the strand may also extend along the outer surfaceof the body in other directions.

As shown in FIGS. 8B and 8C, in another embodiment the strand 60 can belooped through more than one fastener hole 502, 504, 506, 508, 510, forinstance through two holes. The strand can be looped through thefastener holes once or more than once until the desired ratio of activeagent loaded strands 60 to bone plate 500 is achieved.

As shown in FIG. 8D, the strand 60 can be attached to the bone plate 500by looping one or more strands 60 through non-fastener holes 512. Thenon-fastener holes 512 can be any hole that is not typically used toreceive a bone fastener to secure the bone plate 500 to the underlyingbone. In one embodiment the non-fastener holes 512 can extend from thebottom surface 501 to the top surface 503 along a directionperpendicular to the central axis 211 such that a passageway is providedthrough the entire thickness of the bone plate 500. In anotherembodiment the non-fastener hole 512 can extend from one of the bottomsurface 501 or the top surface 503 to the outer periphery 513, such thata passageway is provided through only a portion of the thickness of thebone plate 500.

It will be appreciated by those skilled in the art that changes could bemade to the embodiments described above without departing from the broadinventive concept thereof. It is understood, therefore, that thisdisclosure is not limited to the particular embodiments disclosed, butit is intended to cover modifications within the spirit and scope of thepresent disclosure as defined by the claims.

What is claimed:
 1. An implant comprising: a body having a proximal end,a distal end, and a round outer surface extending from the proximal endto the distal end and defining a substantially circular cross-sectionalong a length of the body from the proximal end to the distal end,wherein the substantially circular cross-section defines an outerdiameter of the body, wherein the body defines a central axis extendingfrom the proximal end to the distal end and wherein the body furtherdefines at least one aperture; and a high tensile strand positionedadjacent the body such that at least a portion of the strand extends atleast partially along the round outer surface of the body outside theouter diameter in a direction substantially parallel with the centralaxis, wherein the strand is at least partially disposed within anaperture of the at least one aperture, and wherein the strand is loadedwith an active agent; wherein an aperture of the at least one apertureextends from the outer surface into the body such that the aperture isangularly offset with the central axis.
 2. The implant of claim 1,wherein the strand is biodegradable.
 3. The implant of claim 1, whereinthe strand further includes a coating layer.
 4. The implant of claim 3,wherein the active agent is disposed as particles within the coatinglayer.
 5. The implant of claim 3, wherein the active agent is dissolvedwithin the coating layer.
 6. The implant of claim 1, wherein the activeagent is dissolved within the strand.
 7. The implant of claim 1, whereinthe active agent is disposed as particles within the strand.
 8. Theimplant of claim 1, wherein the strand includes a monofilament.
 9. Theimplant of claim 1, wherein the strand includes a multifilament.
 10. Theimplant of claim 1, wherein the strand includes at least one ribbon. 11.The implant of claim 1, wherein the active agent includes at least oneantibiotic.
 12. The implant of claim 11, wherein the at least oneantibiotic includes gentamicin.
 13. The implant of claim 1, whereinstrand comprises one or more strands.
 14. The implant of claim 13,wherein the one or more strands are spaced apart from one anotherradially outside the outer diameter of the body along the outer surface.15. The implant of claim 1, wherein the strand is in contact with andconfigured to move or slide against the outer surface of the body duringimplantation.
 16. The implant of claim 1, wherein an aperture of the atleast one aperture is configured to receive a bone fastener.
 17. Theimplant of claim 16, wherein the strand is at least partially disposedin the aperture configured to receive a bone fastener.
 18. The implantof claim 1, wherein the strand is at least partially disposed within theangularly offset aperture.
 19. The implant of claim 1, wherein as thebody is implanted to a bone, at least a portion of the strand is incontact with both the outer surface of the body and the bone.
 20. Theimplant of claim 1, wherein the body includes an inner surface thatdefines a cannula, and wherein the cannula extends in a directioncoaxial with the central axis along at least a portion of the implant,and further wherein the strand is at least partially disposed within thecannula of the body.
 21. The implant of claim 1, wherein the body isconfigured as an intramedullary nail.